Patient handout

Tetanus — generalized + localized + cephalic + neonatal forms + post-exposure prophylaxis (wound-stratified) + active Td/Tdap vaccination during convalescence

PRODUCTION

1. Your condition

This handout is for tetanus — generalized + localized + cephalic + neonatal forms + post-exposure prophylaxis (wound-stratified) + active td/tdap vaccination during convalescence. Your care team identified this based on: trismus ("lockjaw") + risus sardonicus + generalized tetanic spasms triggered by minimal stimuli (light, sound, touch) — generalized tetanus presentation (cook bja 2001 pmid 11517134; who 2018).

Other reasons your team may use this plan: opisthotonos (back arching) + neck rigidity + abdominal-board rigidity — generalized tetanus advanced sign (cook bja 2001); persistent muscle contractions limited to wound-adjacent muscles — localized tetanus (cook bja 2001; who 2018); head/neck wound + cranial nerve palsy (most commonly cn vii) — cephalic tetanus (cook bja 2001; who 2018).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
tetanus_immune_globulin_human	Adult/adolescent: 3000-6000 IU IM single dose (some protocols divide across multiple sites); neonatal: 500 IU IM single dose; pediatric: 3000-6000 IU IM single dose	IM	single dose	Cook BJA 2001 PMID 11517134 + WHO 2018 — TIG neutralizes unbound circulating tetanospasmin; intrathecal administration explored but not standard; FDA-approved for established disease

Plan: Tetanus acute management (diazepam + magnesium + autonomic support + TIG + metronidazole + wound care) + wound-stratified post-exposure prophylaxis (CDC MMWR table) + active Td/Tdap during convalescence (natural infection does NOT confer immunity)

3. When to call your provider

Contact your care team if any of the following happen:

Progression of localized to generalized tetanus → urgent ED + ICU
New autonomic dysfunction → urgent ED
Wound infection / source control failure → surgical evaluation
Cephalic tetanus suspected → urgent ED for admission

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Generalized tetanus (trismus + risus sardonicus + opisthotonos + tetanic spasms triggered by minimal stimuli) — life-threatening; admit ICU + airway protection (intubation low threshold + tracheostomy at 1-2 wk anticipating prolonged spasm) + diazepam continuous infusion (50-200 mg/d titrated) + magnesium sulfate continuous infusion (target serum 2.5-4 mmol/L per Thwaites Lancet 2006 PMID 17055945) + TIG 3000-6000 IU IM + metronidazole 500 mg IV q8h × 7-10 d + wound debridement + active Td/Tdap during convalescence (natural infection no immunity) (Cook BJA 2001 PMID 11517134; Rodrigo Crit Care 2014 PMID 25029486; WHO 2018)(life-threatening)
Spasm-induced respiratory failure / inability to handle secretions / Ablett III-IV severity — life-threatening; intubation low threshold + mechanical ventilation + tracheostomy at 1-2 wk anticipating prolonged spasm (Rodrigo Crit Care 2014 PMID 25029486) + continuous diazepam + magnesium + autonomic management(life-threatening)
Autonomic dysfunction in week 2 of generalized tetanus (labile BP + arrhythmia + hyperthermia + profuse sweating) — modern mortality driver per Rodrigo CCM 2014 PMID 25029486 + Rodrigo Crit Care 2014 PMID 25029486; magnesium sulfate continuous infusion (target serum 2.5-4 mmol/L) + labetalol or esmolol for hypertensive surges + atropine or pacing for bradyarrhythmia; intrathecal baclofen for refractory spasm
Acute wound + post-exposure prophylaxis decision per CDC MMWR wound-stratified table — TIG 250 IU IM + Td/Tdap (separate sites) for all-other wound + < 3 doses or unknown vaccination history; passive + active immunization combination (Liang ACIP MMWR 2018 PMID 29702631; CDC MMWR)
Head/neck wound + cranial nerve palsy (most commonly CN VII facial palsy) — cephalic tetanus; severe; admit + TIG 3000-6000 IU IM + Td/Tdap + metronidazole + wound care + close observation for progression to generalized (~ 30-40% progress); mortality 15-30% in cephalic form alone (Cook BJA 2001 PMID 11517134; WHO 2018)
Newborn 3-14 d post-birth with poor suck → generalized spasms; unvaccinated mother + unsterile umbilical cord care (cow dung, ghee, unsterile blade) — neonatal tetanus; life-threatening; mortality 50-90% globally; NICU + airway + diazepam + magnesium + TIG 500 IU IM + metronidazole + supportive parenteral nutrition; WHO Maternal + Neonatal Tetanus Elimination (MNTE) Initiative — global priority; maternal 2-dose Td during pregnancy + clean delivery prevent (WHO MNTE 2018; Cook BJA 2001)(life-threatening)

5. Follow-up

Post-tetanus convalescence: complete Td/Tdap primary series + lifelong 10-yr boosters (natural infection does NOT confer immunity per Cook BJA 2001; WHO 2018); rehabilitation; cognitive + functional reassessment; psychological support (post-ICU PTSD common); wound care follow-up. Post-PEP: complete Td/Tdap series if incomplete; counsel on lifelong booster schedule. Pregnant: Tdap each pregnancy 27-36 wk for transplacental antibody (Liang ACIP MMWR 2018 PMID 29702631). Public health follow-up through surveillance reporting

6. Sources

Guideline: CDC/ACIP Prevention of Pertussis, Tetanus & Diphtheria with Vaccines — Liang et al, MMWR Recomm Rep 2018 PMID 29702631 (Td/Tdap schedule + wound-stratified PEP + Tdap-in-pregnancy 27-36 wk) + WHO Tetanus position/guidelines 2018 (wound classification + MNTE Elimination Initiative for neonatal tetanus). Clinical management: Cook TM, Br J Anaesth 2001 PMID 11517134 (tetanus review) + Thwaites CL, Lancet 2006 PMID 17055945 (magnesium sulphate RCT) + Rodrigo C, Crit Care 2014 PMID 25029486 (evidence-based pharmacological management).